Eosinophilic Esophagitis Treatment Options

Medically reviewed by Todd Eisner, M.D. — Written by Maureen McNulty
Posted on July 28, 2022

  • Treatment options for eosinophilic esophagitis (EoE) include diet changes, medication, and procedures.
  • You will have to balance your lifestyle and nutrition needs when deciding on a treatment plan with your care team.
  • Finding the right treatment plan may take some trial and error.

Eosinophilic esophagitis develops due to abnormal immune system reactions that affect eosinophils, a type of white blood cell. In this condition, the esophagus (the tube that carries food from the throat to the stomach) becomes irritated and the number of eosinophils within the tissue increases. These immune cells create esophageal inflammation that leads to EoE symptoms such as dysphagia (trouble swallowing), food impaction (food stuck in the throat), chest pain, heartburn, and abdominal pain.

There are several treatments that may improve quality of life for people with EoE. Doctors may recommend diet changes, medication, and procedures. Many people use a combination of therapies. The treatment plan that works best can vary from person to person, so you may have to try several approaches before you find something that works for you.

Dietary Therapy for Eosinophilic Esophagitis

Sometimes, EoE can be managed by avoiding allergens (things that trigger allergic reactions), including certain foods and drinks. If changing your diet is helpful, you may be able to avoid taking medications that could cause side effects. On the other hand, it may be difficult to get proper nutrition and keep your body healthy if you need to eliminate too many foods.

Diets for EoE include:

  • Food test-directed elimination diet — In this strategy, you undergo allergy testing to figure out which foods you are allergic to, and then eliminate those items from your diet.
  • Empiric elimination diet without a food test — This diet includes avoiding all foods and drinks that most often cause allergic reactions, including wheat, dairy, eggs, peanuts, tree nuts, soy, fish, and shellfish.
  • Elemental diet — This approach, which is more than 90 percent effective in the treatment of EoE, involves avoiding any foods or drinks that contain proteins and drinking a liquid containing amino acids (the building blocks of proteins).

It’s helpful to work with other health care providers, like an allergist or a dietitian, when planning a new diet. An allergist can perform testing to help determine your food allergies. Additionally, a registered dietician can assist in building a food elimination diet that meets all your nutritional needs and ensures you aren’t missing any important vitamins or minerals. Your gastrointestinal (digestive) specialist can refer you to these other providers.

Medications for Eosinophilic Esophagitis

EoE medications work in different ways to relieve symptoms or fight the underlying causes of the condition. Work with your doctor to find a drug type and dose that keeps your EoE under control.

Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are medications often used to treat gastroesophageal reflux disease (GERD), a condition in which stomach acid flows up into the esophagus. PPIs have two important roles — they lessen the amount of acid the stomach makes and they protect against inflammation. Both of these roles can help treat symptoms of EoE.

PPIs are often the first recommended treatment for EoE, but they don’t work for everyone. If you have tried these drugs and continue to have symptoms, your doctor may recommend other medications.

Topical Corticosteroids

Steroid medications, also called corticosteroids, decrease the activity of the immune system in order to reduce inflammation. Steroids can be either topical (medications applied directly to the affected area) or systemic (medications that travel throughout the bloodstream to all of the body’s tissues).

Eosinophilic esophagitis is most often treated with topical steroids, which have fewer side effects than systemic medications. In EoE, the affected tissue is the lining of the esophagus, so topical steroids are applied by swallowing them. Although no topical steroids are officially approved by the U.S. Food and Drug Administration (FDA) for EoE, two medications are known to help with this condition:

  • Fluticasone (Flovent) — This medication is usually swallowed from an inhaler.
  • Budesonide (Entocort EC) — This medication is a liquid that is typically eaten after forming a “slurry” with a thickening agent like Splenda, applesauce, or honey.

These medications both have similar effects in lowering the eosinophil count within the esophagus and helping people avoid EoE symptoms.

Biologic Medications

One biologic is FDA-approved to treat EoE — dupilumab (Dupixent). This medication was approved in 2022 for adults or adolescents 12 years old and up. It is a monoclonal antibody (protein that modifies part of the immune system) that can help prevent inflammation and damage within the esophagus.

One study found that 64 percent of people who took dupilumab had fewer EoE symptoms. People with EoE who took dupilumab were 10 times more likely to go into remission compared to those who received a placebo (a “fake” treatment that has no medical effects).

Additional clinical trials — research studies to evaluate treatments — are analyzing whether other biologic drugs may also help people with EoE. In the future, there may be additional medication options for this condition.

Procedures for Eosinophilic Esophagitis

EoE often leads to fibrosis (buildup of scar tissue) and strictures (narrowing) within the esophagus. This can make it more difficult for food to pass through.

Esophageal dilation is a procedure that can help widen the esophagus and make eating easier. You may choose to try this procedure if medications aren’t helping or if you don’t want to deal with their side effects.

Esophageal dilation is often performed at the same time as an upper endoscopy. During an endoscopic procedure, a long, thin tube with a camera is passed into the mouth, down the esophagus, and into the stomach or small intestines. An endoscopy can be used to take a biopsy (tissue sample), diagnose digestive system problems, or administer treatments such as esophageal dilation.

Esophageal dilations can be very effective, helping improve symptoms for 95 percent of people. However, they often need to be repeated multiple times to achieve the best results. Problems may also occur during a dilation — for example, it may lead to a perforation (hole or tearing) in the esophagus.

Esophageal dilation is particularly beneficial if there is a stricture in your esophagus. While serious problems occur less than 1 percent of the time with this procedure, the risk of perforation is increased for people who do not have a stricture.

Deciding on a Treatment Plan

To determine the optimal approach for treating your EoE, you may want to talk over the options with your primary physician as well as with other health care providers, such as your gastroenterologist, allergist, or dietitian.

It may take some trial and error before you find the right treatment plan. Make sure to attend all of your follow-up appointments, and let your health care team know if treatments don’t seem to be working or you experience any health changes.

Talk With Others Who Understand

On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to gain a new understanding of EoE and share their stories with others who understand life with EoE.

What treatments have you tried for eosinophilic esophagitis? Share your experience in the comments below.

Posted on July 28, 2022

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Todd Eisner, M.D. has 32 years of experience in gastroenterology and internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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